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AJNR - American Journal of Neuroradiology

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MR Diffusion Tensor Imaging, Fiber Tracking, and Single-Voxel Spectroscopy Findings in an Unusual MELAS Case

Denis Ducreux^a, Ghaidaa Nasser^a, Catherine Lacroix^b, David Adams^b and Pierre Lasjaunias^a

^a Department of Neuroradiology and the Intensive Care Unit, CHU de Bicêtre, Paris XI University, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
^b Department of Neurology and the Intensive Care Unit, CHU de Bicêtre, Paris XI University, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France

View larger version (93K): [in a new window]   FIG 1. Axial fluid-attenuated inversion recovery MR (A) and diffusion-weighted b0 (B) images show an abnormal area in the right mesencephalon (arrows). Apparent diffusion coefficient (C) and fractional anisotropy (D) color-scale parametric maps show an increased apparent diffusion coefficient and decreased fractional anisotropy values (green) in the same abnormal area (B) (arrowheads).

View larger version (70K): [in a new window]   FIG 2. Spinal cord sagittal T2-weighted MR (A) and diffusion-weighted b0 (B) images show wide intraspinal abnormal areas (arrows). Apparent diffusion coefficient (C) and fractional anisotropy (D) color-scale parametric maps show increased apparent diffusion coefficient and decreased fractional anisotropy values (green) in the same abnormal area (arrowheads).

View larger version (65K): [in a new window]   FIG 3. Spinal cord sagittal T2-weighted MR (A) and diffusion-weighted b0 (B) images show wide intraspinal abnormal areas (arrows). Fiber tracking (C), coregistered and projected on a T2-weighted image, shows an unexpected unaltered shape of the white matter tracts, with visualization (D) of corticospinal tracts and nerve roots (arrowhead).

View larger version (72K): [in a new window]   FIG 4. Sagittal T2-weighted MR image (A) shows extensive abnormal areas involving the brain stem and the cervical spinal cord (arrow). A long TE MR spectroscopy voxel was located on fluid-attenuated inversion recovery abnormal areas in the medulla oblongata (B, arrow) and showed a spectrum with increased Cho peak, decreased NAA peak, and an inverted 1.3-ppm lactate peak (Lac, arrow box). Cr indicates creatine.